Provider Demographics
NPI:1750462818
Name:AMADOR, RAFAEL (OD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:AMADOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PLACID COURT
Mailing Address - Street 2:3-C
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-753-1033
Mailing Address - Fax:
Practice Address - Street 1:525 AVE FD ROOSEVELT STE 140
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8020
Practice Address - Country:US
Practice Address - Phone:787-753-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU196269Medicare UPIN